Dirty Talk in Addiction

Posted on May 24, 2018

by Thaddeus Camlin, Psy.D.

Here at Practical Recovery we’ve done a number of pieces on the language of addiction. I personally consider the article It’s Time to Clean Up The Language of Addiction, by Anne Fletcher, MS, RD, to be a foundational cornerstone to quality addiction treatment. In recent weeks a particularly common term in addiction treatment, one highlighted in Fletcher’s landmark piece, has been gnawing away at me – dirty. The complex histories that shape addictive behavior, combined with moral associations to the term dirty make for a potent, insidious label that deserves swift eradication.

The term ‘dirty’ in addiction and recovery circles is about as much of a staple to the industry’s vernacular as the term ‘bottom line’ is in the finance industry. The world of addiction and recovery is literally defined by a dichotomy of clean and dirty. If I’m ‘in my addiction,’ I’m dirty. If I’m sober, I’m clean. The whole point to recovery is to “get clean.” Urine (aka liquid gold) is routinely analyzed for metabolites of drugs and if found, I’m dirty. The idea that the presence of metabolites of arbitrarily illegal substances in urine makes a human dirty is erroneous and laughable. Somebody with alcohol or cannabis or opiate or stimulant metabolites in their urine is no less clean than someone without those metabolites.

Common Courtesy in Addiction Treatment

This article is not intended to be a piece advocating for safe spaces and a denial of reality. This article is intended to be a piece advocating for common courtesy and human decency. Research clearly indicates that people with substance use disorders are significantly more likely to have a history of sexual abuse than the general population. Additionally, sexual abuse is notoriously under-reported, which suggests that large portions of people who seek addiction treatment have been sexually abused and many of them have never disclosed it. SMART Recovery co-founder Dr. Tom Horvath and HBO comic John Oliver both recently did pieces on how addiction treatment can be harmful, and one glaring example of why is strikingly present when we consider the implications of branding someone who has been sexually abused as ‘dirty.’ If we run around calling everyone in addiction treatment who ingests a substance dirty, odds are, we are calling people who have been sexually abused dirty with disgusting frequency.

People who have been sexually abused often take long showers in a valiant effort to feel clean. To call people who have been sexually abused dirty for ingesting substances that provide some relief to their suffering is preposterously sickening and cruel, and it is absolutely insane to think that the practice is widely and generally regarded as ‘treatment.’ Anybody seeking help who is called ‘dirty’ by a so-called treatment provider should leave immediately and consider reporting the individual to a licensing and ethics board. Unfortunately, the licensing and ethics board will likely do nothing because they subscribe to the same cruel treatment methods.

Why not refer to “dirty” drug tests as negative, isn’t that more accurate and not judgment laden? Potential grammar issues aside, wouldn’t it be more accurate to say that people go to treatment to “get healed” rather than to “get clean?” We go to treatment for healing, not cleaning. As Anne Fletcher points out, it is unconscionable for a treatment provider to call someone trying to lose weight a ‘fat slob,’ but nobody blinks an eye when a so-called counselor calls someone trying to change a pattern of substance use a ‘dirty junkie.’ Not only can addiction treatment be harmful, it often is. I can’t think of something much more sadistic than repeatedly referring to someone who has been sexually abused and uses substances to cope as dirty.